Sensory System Lower Limb
Washes hands, appropriate dress and grooming. Introduces self and asks for consent. * *Wash hands* * Hello my name is Student and I'm a first year medical student at School can I please get your full name and age. * Mr. Doe, my attending physician has asked me to check the sensory system in your legs, do I have your permission? Explains procedure to patient, positions and drapes * Today we'll need your legs exposed and I'll be touching various parts of your legs to make sure the feelings are intact; are you comfortable with this? * I just want to remind you that anything we find will be confidential. * Is there anything you need before we begin? * The patient is seated and I'm going to drape the patient to expose his legs. Light touch / Demonstrate / Compares distal with proximal results * Mr. Doe I'm going to be touch parts of your leg with this cotton wisp, please close your eyes and say "now" when you feel the cotton wisp touching your leg. * I'm going to demonstrate Light Touch at Dermatomes L1 through S1. * The patient was able to feel the cotton swab in all areas which suggest he does not have a peripheral neuropathy. Test for PAIN bilaterally in the major dermatomes. Comment on findings. * Mr. Doe, I'm now going to perform the same test using the end of this instrument, please close your eyes and say "now" when you feel it touching your leg. Check for Vibration Sense in big toes bilaterally using a 128 Hz tuning fork at the distal bony prominence of the big toe. Assess for ability to tell when vibration ceases. Comment on findings * Mr. Doe, I'm going to place this tuning fork on your big toe; please tell me when it stops vibration. * The patient was able to feel vibration which is normal. * Loss of vibration sense can suggest peripheral neuropathy caused by diabetes, alcoholism, or Vitamin B12 deficiency. Check for Proprioception in the big toes bilaterally, holding the toe laterally at the distal phalange, and asking the patient to close eyes. Give preview of upward and downward movement before testing. Comment on findings. * Mr. Doe, I'm going to be moving your big toe, please let me know which direction your toe is being moved. * This is up, this is middle and this is down. * Please close your eyes. * The patient's proprioception is intact. * Loss of proprioception can be caused by: ** Diabetes ** Alcoholism ** Vitamin B12 deficiency Check for a Romberg Sign. Comment on findings and explain significance of a positive Romberg sign. * Mr. Doe, please stand up with your feet together and close your eyes for 30 seconds. * The patient was able to stand up for 30 seconds which is a negative Romberg sign. * If the patient loses balance with their eyes is closed, this is a positive Romberg sign and can suggest dorsal column disease. Knowledge Question * What is the function of the Spinocerebellar tract or Dorsal Column? ** Proprioception ** Touch ** Pressure ** Vibration * What is the function of the Spinothalamic tract? ** Pain ** Temperature